Purpose :
To compare visual acuity (VA) outcomes in year 1 of treatment with aflibercept vs. ranibizumab for eyes with wet macular degeneration (nAMD) treated in two centres by two different treatment regimens.

Methods :
Retrospective analysis from an electronic medical record (EMR). 100 Treatment-naïve eyes with nAMD received therapy with aflibercept or ranibizumab intravitreal injections (IVI)s. In Group A (University Hospital Southampton: 51 eyes) aflibercept was used per VIEW modified protocol. In Group B (West Suffolk Hospital: 49 eyes) ranibizumab was used per Treat and Extend (T&E) protocol.Group A received Aflibercept per VIEW protocol (Q8W) with a total of 3 Clinic Visits (3 OCTs) during a year of treatment.Group B received Lucentis per T&E protocol: after a loading of 3 IVIs, inter-IVI interval was extended/shortened by 2 weeks based on disease activity.Mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at year 1 compared to baseline, mean number of injections and visits were collected. Economic analysis was performed based on data from the coding department.

Results :
Baseline parameters were well matched (Age, baseline BCVA). The mean VA of Group A eyes improved from 0.49 LogMar at baseline to 0.34 LogMar (+7.5 ETDRS L gain [P = 0.0010]) at end of year 1 (Y1), compared with 0.48 LogMar at baseline to 0.32 LogMar (+8.3 ETDRS L gain [P < 0.0001]) for Group B. Mean BCVA Group A vs mean BCVA Group B (P=0.1550). The mean CRT of Group A improved from 296 μm at baseline to 214 at Y 1. The mean CRT of Group B improved from 428 μm at baseline to 272 at Y1. In Group A vs. Group B comparisons, the mean numbers of IVIs were 7 vs. 7.75 (P < 0.0001) and Clinic Visits were 3 vs. 5.75 (P=0.0001). In the T&E group IVI and Clinic Visit numbers ranged from 5-11. Economic analysis revealed the total mean cost per patient per annum was £6919.00 for aflibercept per Southampton protocol, £7395.00 for ranibizumab per the T&E protocol.

Conclusions :
Visual gains were significant and comparable for both Aflibercept (Q8W) and Ranibizumab (T&E) used proactively in year 1. Differences between the 2 regimens were significant when mean numbers of IVIs and Clinic Visits were compared. From an economic point of view, Southampton protocol for Aflibercept is more cost effective compared to T&E for Ranibizumab in Y1 of treatment. Larger case series AND/OR RCTs are needed to give further evidence.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.